Assymetric eyes, Orbital Decompression

[Marelago]

Hi
I'm a longtime sufferer abouth how my eyes looks. At this point I have to say, that I already had upper Ptosis surgery on both eyes and an endoscopic browlift to lift my eybrows. I whant more hooded eyes with less upper eyelid exposition and lower exposure sclera on the sides with lower eyelid surgery.
I think that the endoscopic browlift lifted my soft tissue to much so my upper eyelids are hollow and prominent.
I was by many oculoplastic surgeons, and also maxillo facial surgeons. A wide variety of opinions are available to solve the problem:

Orbital decompression: this idea came from an US surgeon Because He thinks that he can't archieve a natural result only with fixing upper eyelid overcorrection (from ptosis surgery), and lift the lower eyelids lateral with canthoplasty. So he would do OD and correction eyelids.
I'm hesitant abouth this surgery because it's relatively invasive and other oculoplasti surgeon said that I have eyeballs in normal range after he measured it. But the us surgeon is right that my cosmetic eye problem would be solved with OD and some work on the eyelid in the best manner. He said me also that I would look 30-40 percent better with OD and eyelid surgery. It would cost me around 24k usd with anasthesia and staying one night in hospital.
Other oculoplastics would only correct the left upper eyelid (overcorrection).
Some maxfacs said that the problem are the flat cheeks that would pretend that I have overexposed eyeballs. Some surgeon would do an augmentation with bone grafts foremost paranasal.

I'm torn between the proposed OD from US surgeon or do a more conservative approach like fixing only the eyelids (foremost the left eye), cheek augmentation.
A reverse browlift is also pretty invasive but I would take this surgery also in consideration.

What you think? Thanks

 

[optimisticzoomer]

Probably don't get orbital decompression, just get implants or Botox or something, it looks like you're raising your eyebrows

 

[optimisticzoomer]

Also fix your hair and get rid of that ponytail thing, and get rhino

 

[depressionmaxxing]

Nice softmax would be denser eyebrows and why would you lift them, they‘d look better when positivly tilted (yours r round).

 

[MaestheticMaso]

Probably don't get orbital decompression, just get implants or Botox or something, it looks like you're raising your eyebrows

Orbital decompression will help with implants later down the line. It will look more natural.

Shallow set eyes and then implants will look uncanny

 

[Marelago]

optimisticzoomer "Probably don't get orbital decompression, just get implants or Botox or something, it looks like you're raising your eyebrows". Yeah you see it right I look like I raise my eyebrows permanently. This look on me has to do with the overdone browlift years ago. I think this is also the most glaring part on my face. It's not the eyes that are protruding but the high eyelids lift the upper tissue of the Eyelids so they look so prominent. I think this would be the first thing to fix.
How would you fix my nose? So that my bump is removed (I broke it 15 years ago)? Or would you also project the tip of the nose that it would have a wider angle to the upper lip (more than 90°), and maybe shorten the bridge a little bit? Thanks for you input.

 

[Marelago]

@maesthicmaso "
Orbital decompression will help with implants later down the line. It will look more natural.
Shallow set eyes and then implants will look uncanny".

the US orbital surgeon didn't do implants he would "only" do orbital decompression and then align the upper and lower eyelids.
I never saw a decent post result with orbital rim implants. I can augment my cheek region with lypophiled bone also the orbital rims.
But the question is should I do it or only fix my botched overcorrected left eyelid with doing also cantoplasty on the lower eyelids. The US surgeon mean that he can't obtain good outcome only doing the eyelids without the OD. Im not so shure abouth that.

 

[MaestheticMaso]

@maesthicmaso "
Orbital decompression will help with implants later down the line. It will look more natural.
Shallow set eyes and then implants will look uncanny".

the US orbital surgeon didn't do implants he would "only" do orbital decompression and then align the upper and lower eyelids.
I never saw a decent post result with orbital rim implants. I can augment my cheek region with lypophiled bone also the orbital rims.
But the question is should I do it or only fix my botched overcorrected left eyelid with doing also cantoplasty on the lower eyelids. The US surgeon mean that he can't obtain good outcome only doing the eyelids without the OD. Im not so shure abouth that.

Hmmm, I would get the OD and the eyelid alignment and then surely you can do implants later down the line with another surgeon ? Or would that not be possible after OD?

 

[MaestheticMaso]

@maesthicmaso "
Orbital decompression will help with implants later down the line. It will look more natural.
Shallow set eyes and then implants will look uncanny".

the US orbital surgeon didn't do implants he would "only" do orbital decompression and then align the upper and lower eyelids.
I never saw a decent post result with orbital rim implants. I can augment my cheek region with lypophiled bone also the orbital rims.
But the question is should I do it or only fix my botched overcorrected left eyelid with doing also cantoplasty on the lower eyelids. The US surgeon mean that he can't obtain good outcome only doing the eyelids without the OD. Im not so shure abouth that.

Tagging an expert in this:
@RealSurgerymax: what should he do ?

 

[Marelago]

Hmmm, I would get the OD and the eyelid alignment and then surely you can do implants later down the line with another surgeon ? Or would that not be possible after OD?

Did you think my eyes are protrudet that OD would be warranted or in other words only eyelid surgery wouldn't do the job? I'm not against orbital decompression surgery when I would benefit from this surgery considerably I would do it. Yes the implants can be done after the OD and eyelid surgery.

 

[NarrowBones]

Don’t get OD I like your cute feminine girl eyes

 

[MaestheticMaso]

Did you think my eyes are protrudet that OD would be warranted or in other words only eyelid surgery wouldn't do the job? I'm not against orbital decompression surgery when I would benefit from this surgery considerably I would do it. Yes the implants can be done after the OD and eyelid surgery.

They do protrude, but it doesn’t seem bad enough to affect health, when traditional ODs are usually done. But I think it would result in a more natural look, especially if you get implants after. That’s the main thing.

 

[Marelago]

Don’t get OD I like your cute feminine girl eyes

Thank U )) 6.23 height.

 

[damnit]

imo your eyes arent produing enough to be considering invasive procedures like orbital decompression, looks like soft tissue changes can be made for correction of assymetry . canthoplasty to one side and a ptosis surgery to the other side can impact your symmetry . Also fillers/upper grafts to look more hooded if you can.

 

[lookmaxxer998]

Hi
I'm a longtime sufferer abouth how my eyes looks. At this point I have to say, that I already had upper Ptosis surgery on both eyes and an endoscopic browlift to lift my eybrows. I whant more hooded eyes with less upper eyelid exposition and lower exposure sclera on the sides with lower eyelid surgery.
I think that the endoscopic browlift lifted my soft tissue to much so my upper eyelids are hollow and prominent.
I was by many oculoplastic surgeons, and also maxillo facial surgeons. A wide variety of opinions are available to solve the problem:

Orbital decompression: this idea came from an US surgeon Because He thinks that he can't archieve a natural result only with fixing upper eyelid overcorrection (from ptosis surgery), and lift the lower eyelids lateral with canthoplasty. So he would do OD and correction eyelids.
I'm hesitant abouth this surgery because it's relatively invasive and other oculoplasti surgeon said that I have eyeballs in normal range after he measured it. But the us surgeon is right that my cosmetic eye problem would be solved with OD and some work on the eyelid in the best manner. He said me also that I would look 30-40 percent better with OD and eyelid surgery. It would cost me around 24k usd with anasthesia and staying one night in hospital.
Other oculoplastics would only correct the left upper eyelid (overcorrection).
Some maxfacs said that the problem are the flat cheeks that would pretend that I have overexposed eyeballs. Some surgeon would do an augmentation with bone grafts foremost paranasal.

I'm torn between the proposed OD from US surgeon or do a more conservative approach like fixing only the eyelids (foremost the left eye), cheek augmentation.
A reverse browlift is also pretty invasive but I would take this surgery also in consideration.

What you think? Thanks

I think the brow lift is definitely contributing to the prominence of your eyes. With regards to OD or implants, I would say both could be beneficial. You present with a negative orbital vector, which can be attributed to primarily underdeveloped infraorbital rims and Malar hypoplasia as your brow ridge does protrude beyond the anterior most position of the cornea. Idk which US surgeon you went to- if it's Raymond Douglas, he seems to be kind of anti implants. Where as Dr. Taban does both implants and OD. It may be worth finding a surgeon who does both OD and rim implants to see what's the best option. Although, implants are best done custom made and by maxillofacial surgeons rather than the generic implants used by oculoplastic/adnexal surgeons.

As far as I know, infra implants don't interfere with potential OD in the future so perhaps start of with a reversing the brow lift and getting implants and if it isn't enough pursue OD. The worrying thing about OD is that despite all the advances in deep wall decompression (made primarily by a guy called Robert A Goldberg- who I believe no longer does Orbital surgery), there is still some chance to encounter double vision. This is the primary complication of this surgery (more so than blindness). I would ask more than one surgeon before pursing an OD because you should be fairly sure about it. Usually, the lateral wall ( sometimes in combination with the medial wall ) is/are decompressed and decompression for cosmetic purposes is usually less to prevent complications down the line.

 

[Marelago]

imo your eyes arent produing enough to be considering invasive procedures like orbital decompression, looks like soft tissue changes can be made for correction of assymetry . canthoplasty to one side and a ptosis surgery to the other side can impact your symmetry . Also fillers/upper grafts to look more hooded if you can.

@damint Thanks for your input. The eyeballs are either protrudet or my midface is recessed especially orbital rims (seeing better in profile pics),
It seems that I have negative orbital vector.
But you're right, canthoplasty and ptosis surgery can improve my aesthetic situation but I guess it won't last for an 30-50 % improvement of my midface and eye area. Maybe OD is appropriate in my case.

I think the brow lift is definitely contributing to the prominence of your eyes. With regards to OD or implants, I would say both could be beneficial. You present with a negative orbital vector, which can be attributed to primarily underdeveloped infraorbital rims and Malar hypoplasia as your brow ridge does protrude beyond the anterior most position of the cornea. Idk which US surgeon you went to- if it's Raymond Douglas, he seems to be kind of anti implants. Where as Dr. Taban does both implants and OD. It may be worth finding a surgeon who does both OD and rim implants to see what's the best option. Although, implants are best done custom made and by maxillofacial surgeons rather than the generic implants used by oculoplastic/adnexal surgeons.

As far as I know, infra implants don't interfere with potential OD in the future so perhaps start of with a reversing the brow lift and getting implants and if it isn't enough pursue OD. The worrying thing about OD is that despite all the advances in deep wall decompression (made primarily by a guy called Robert A Goldberg- who I believe no longer does Orbital surgery), there is still some chance to encounter double vision. This is the primary complication of this surgery (more so than blindness). I would ask more than one surgeon before pursing an OD because you should be fairly sure about it. Usually, the lateral wall ( sometimes in combination with the medial wall ) is/are decompressed and decompression for cosmetic purposes is usually less to prevent complications down the line.

@lookmaxxer1998 YOU ARE SPOT ON regarding my case I think. I'm a bit hesitantly concerning the rim implants. But I agree with you that I have some sort of hypoplasia that affectcs also the infraorbital rims. Interesting detail is, that all maxfac that I went said that they would augment my cheecks foremost paranasal (with cartillage bone not implants), so they can also augment my surpressed Infraorbital rims. But no Maxfac said that I also would improve when doing Orbital decompression because they think the eyes aren't protrudet but my midface is to backwards. It's a bit contradictory because with Orbital Decompression (it's the first surgeon you mentioned) the negative orbital vector would also improve and maybe than cheek augmentation is not even necessary when ther orbital vector would be positive after OD. Yes my browridge is far more projected then my nonexistent cheecks (front), lateral is imo better projection. But I think foremoost in men that the browridge is always more advanced then the supraorbital rims but maybe not in a such range like my case?
I can explain this that when I was a child I wear braces ( monobloque) during the night to put my upper teeths more backwards. I wear this every night for three years. This could be the cause that I have some recessed Midface and Maxilla.

I think you nailed it where the problem is. That the brows also simulate an exopthalmus is right and of course the overprojected upper left eyelid. Maybe only reducing the lateral projection of the brows and also fixing the overprojected left eyelid would improve my situation drastically?

I attached some photo profile so the negative orbital vector is also more visible. Which surgeries in your opinion would I benefit the most?
I ask because there is discrepancy among the maxfac surgeons and Oculoplastic surgeons (see also my first post). Would it be more a midface advancement eye rims and paranasal cheeks, maybe also my whole maxilla puting more in front?

But it would be maybe to eaMaybe even a lefort 2 or 3? Or would an Orbital decompression executed from a surgeon state of the art with 4-5 mm less projection of the eyeballs and maybe than some rimimplants also improve my aesthetic situation drastically?
Thank you.

 

[lonelycurry]

old ass fuck

 

[klamus]

I honestly dont think it would affect your smv. Your looks level would still Be about The same.

 

[Marelago]

I honestly dont think it would affect your smv. Your looks level would still Be about The same.

@klamus I don't agree with this. I see improvement. Maybe the pictures don't show the full truth how I really look. Random people judge me on the streets or when I'm in a club, bar (that I go rarely). I'm realatively tall and athletic but that doesnt give me more chances in Job or private life.
Socializing with other people foremost women is impossible till I'm intelligent, funny, but this doesnt' matter for them they are at unease. They don't whant know me because how I look. Maybe it's also because I don't look swiss but more scandinavian but I don't see much changes in other countries how ohter people threat me.
It's the negative orbital vector, the overexposed left eyelid that frightened people when they see me. I have recessed midface and exposed eyeballs.
Maxillofacial surgeons all agree that the most promising surgery to fix this flaw would be cheek augmentation with lypophyled bone so also the infraorbital rims could benefit from this surgery. I go further I'm a candidate for lefort 2 or 3 (I'm too little informed if a lefort 2 could also improve my under eye region).
As I don't understand that no maxillofacial surgeon proposed me also jaw surgery lefort 1-3 ?because my upper teeths ar not in normal range too backwards ?

Now a famous oculoplastic surgeon proposed me Orbital decompression and then align the soft tissue with some eyelidsurgeries (foremost the overexposed left upper eyelid, and canthoplasty). It makes sense what he says that only eyelid surgery wouldn't bring a good result on the table. But he didn't agree that my midface is underdevelopped he thinks that the overexposed eyeball are the culpirits.

As I agree with him in some part, I ogle with cheek augmentation, or more drastically lefort 2 or 3. And I'm unshure which way to go? Only Orbital decompression with eyelid revision or cheek augmentation or even lefort 2 or 3? So anyone who has an opinion on my case can express your opinion here.
(the third pics shows the problem imo the best).

 

[optimisticzoomer]

optimisticzoomer "Probably don't get orbital decompression, just get implants or Botox or something, it looks like you're raising your eyebrows". Yeah you see it right I look like I raise my eyebrows permanently. This look on me has to do with the overdone browlift years ago. I think this is also the most glaring part on my face. It's not the eyes that are protruding but the high eyelids lift the upper tissue of the Eyelids so they look so prominent. I think this would be the first thing to fix.
How would you fix my nose? So that my bump is removed (I broke it 15 years ago)? Or would you also project the tip of the nose that it would have a wider angle to the upper lip (more than 90°), and maybe shorten the bridge a little bit? Thanks for you input.

Remove bump, raise and narrow tip, cut depressor septi nasi muscle to reduce plunging tip

Btw you can press reply to a comment so people are notified

 

[Marelago]

Remove bump, raise and narrow tip, cut depressor septi nasi muscle to reduce plunging tip

Btw you can press reply to a comment so people are notified

Thanks for your assesment. I don't think rhino alone would correct my flaws. I discovered new constructed side, beside the botched Eye region, when I did simulasion with tape to upper my nose tip.
It looks like that I have maxillary recession and also jaw.
If the nose only would be better projected (removing bump, and lift the tip, it would look uncanny imo because the maxilla and jaw would be too backwards ant the philtrum that's already long would be even longer.
And the negative orbital vector is there and wouldn't change with some invasive shit, like le fort 2 or 3 and (or) orbital decompression.

Can someone point out if it's only the maxilla that's recessed or also the jaw? Because if only maxilla is affected I could do only bone augmentation cheeks (infraorbital rims, paranasal), after I would correct my nose. If also the jaw is recessed than jaw surgery with some rotation and Lefort would be better solution, and then augment the cheeks with bone augmentation or implants.

I also did some simulation with tapes to show how it could look when fixing my eyelids. Imo it did not much. Ok the left eyeball is less exposed (see photo sideprofile).

 

[rubberduck]

How old are you man? You look old af lol. First thing I would get rid of that bizarre looking hair. A guy who you slightly resemble who is a handsome is retired hockey player Jeremy Roenick, I would try to look more like him

 

[Marelago]

I think som short videos of me are more revealing how I look (and how I could look with simulation tape).
The recessed maxilla doesn't show on video, also not the flat cheeks so I think it has to do with my fotos taken to close that gives the impression of that.

I did two videos of me. the first how i look actually, the second with simulating eyelid correction/and without tapes how I look.
Im confident that some eyelid surgery and maybe OD would improve my flaws. What do you think?

 

[Dream99]

too old to slay white girls goto thailand they'll love you

 

[Marelago]

I think som short videos of me are more revealing how I look (and how I could look with simulation tape).
The recessed maxilla doesn't show on video, also not the flat cheeks so I think it has to do with my fotos taken to close that gives the impression of that.

I did two videos of me. the first how i look actually, the second with simulating eyelid correction/and without tapes how I look.
Im confident that some eyelid surgery and maybe OD would improve my flaws. What do you think?

How old are you man? You look old af lol. First thing I would get rid of that bizarre looking hair. A guy who you slightly resemble who is a handsome is retired hockey player Jeremy Roenick, I would try to look more like him

Thanks for your input at critics. My hairs get grayer and grayer. I'm not so old. Yes the hairs look bizarre because I can't do a pony with my front hairs (because they are too short). But thanks maybe better I do another hair cut.

I don't think I slightly resemble Jeremy Roenick. He has another face structure than me (broader jaw, deeper hairline, pinned ears).

 

[Marelago]

too old to slay white girls goto thailand they'll love you

Thailand I'm coming sunglasses already bought

 

[Dream99]

Thailand I'm coming sunglasses already bought

yessaar

 

[optimisticzoomer]

Thanks for your assesment. I don't think rhino alone would correct my flaws. I discovered new constructed side, beside the botched Eye region, when I did simulasion with tape to upper my nose tip.
It looks like that I have maxillary recession and also jaw.
If the nose only would be better projected (removing bump, and lift the tip, it would look uncanny imo because the maxilla and jaw would be too backwards ant the philtrum that's already long would be even longer.
And the negative orbital vector is there and wouldn't change with some invasive shit, like le fort 2 or 3 and (or) orbital decompression.

Can someone point out if it's only the maxilla that's recessed or also the jaw? Because if only maxilla is affected I could do only bone augmentation cheeks (infraorbital rims, paranasal), after I would correct my nose. If also the jaw is recessed than jaw surgery with some rotation and Lefort would be better solution, and then augment the cheeks with bone augmentation or implants.

I also did some simulation with tapes to show how it could look when fixing my eyelids. Imo it did not much. Ok the left eyeball is less exposed (see photo sideprofile).

In some pics you look like u could use bimax, others not so much. Also, your nasomental angle (angle of philtrum basically) is such that your philtrum slopes backwards towards your lips, rather than the ideal which would be a concave angle philtrum. Bimax would probably improve this. Because of that, I don't think implants would be ideal alone as then your lower maxilla would look more set back.

Also, your nose looks better in those morphs, although not dented in like in some of them

 

[Marelago]

In some pics you look like u could use bimax, others not so much. Also, your nasomental angle (angle of philtrum basically) is such that your philtrum slopes backwards towards your lips, rather than the ideal which would be a concave angle philtrum. Bimax would probably improve this. Because of that, I don't think implants would be ideal alone as then your lower maxilla would look more set back.

Also, your nose looks better in those morphs, although not dented in like in some of them

Thanks that what I had suspected. Bimax first to do.

 

[Marelago]

another pic when smirking my cheeks actually didn't look so recessed.

 

[depressionmaxxing]

OP you‘re too old for surgery

 

[Marelago]

I studied my case again. It's apparent that my side profiles aren't equal (not same forward growth maxilla)s. videos.
the left side is better projected.
This was foremost botched because I weared braces as a child, pulling the upper teeths back.
Interestingly when I relax my jaw I would have an overbite. Because my jaw is forced to go back (because of my recessed maxilla) when I put the teeths together.

beside the overcorrected left eyelid I think the cause that my eyes are protruding is the lack of forward projection infraorbital rims, cheeks and some proptosis of the eyeballs.
Maybe one eye could also be set a bit lower (left eye)?
The supraorbital rims imo are well grown forward, that's why the eyes don't protrude when I take pictures from above. And the risk with orbital decompression could be that my eyes would cosmetically vanish when looking up because of the supraorbital rims. I attached also some CT-Scans of the Orbits etc.


Something in the midface region is recessed so far that it's glaring . but can't point what it is? Maybe downward grown orbits? Or recessed whole maxilla complex? Or just that my Eyballs are to much forward (orbital decompression), or my eye rims cheek region.?

WHEN WE LOOK AT THE NOSE on the profile. There's no forward grow on the nasion.
Maybe this could justify the le fort 3 surgery . So that my protruding eyes would vanish and my recessed midface incl. jaw.
What you think would be appropriate in my case? I ask becaus till this spring I whant decide which way I whant to go to fix it.

 

[Sodoku]

I studied my case again. It's apparent that my side profiles aren't equal (not same forward growth maxilla)s. videos.
the left side is better projected.
This was foremost botched because I weared braces as a child, pulling the upper teeths back.
Interestingly when I relax my jaw I would have an overbite. Because my jaw is forced to go back (because of my recessed maxilla) when I put the teeths together.

beside the overcorrected left eyelid I think the cause that my eyes are protruding is the lack of forward projection infraorbital rims, cheeks and some proptosis of the eyeballs.
Maybe one eye could also be set a bit lower (left eye)?
The supraorbital rims imo are well grown forward, that's why the eyes don't protrude when I take pictures from above. And the risk with orbital decompression could be that my eyes would cosmetically vanish when looking up because of the supraorbital rims. I attached also some CT-Scans of the Orbits etc.


Something in the midface region is recessed so far that it's glaring . but can't point what it is? Maybe downward grown orbits? Or recessed whole maxilla complex? Or just that my Eyballs are to much forward (orbital decompression), or my eye rims cheek region.?

WHEN WE LOOK AT THE NOSE on the profile. There's no forward grow on the nasion.
Maybe this could justify the le fort 3 surgery . So that my protruding eyes would vanish and my recessed midface incl. jaw.
What you think would be appropriate in my case? I ask becaus till this spring I whant decide which way I whant to go to fix it.

I don't think your protruding eyes are the issue, it's more that they are narrow set i.e. your IPD is the problem imo. The way to fix that via surgery is OBO which is something @RealSurgerymax has done

Happy for others to chip in here

 

[RealSurgerymax]

I don't think your protruding eyes are the issue, it's more that they are narrow set i.e. your IPD is the problem imo. The way to fix that via surgery is OBO which is something @RealSurgerymax has done

Happy for others to chip in here

Yes you are correct.

In this case we would move the orbits further apart and also advance them as a unit. Moving the periorbital rims forward in obo about 4mm would would have the exact same effects as orbital decompression except better for forward growth. We would do it at the same time as widening them.

 

[yeeyeeslayer]

dnrd but how old r u

 

[yeeyeeslayer]

Yes you are correct.

In this case we would move the orbits further apart and also advance them as a unit. Moving the periorbital rims forward in obo about 4mm would would have the exact same effects as orbital decompression except better for forward growth. We would do it at the same time as widening them.

are u an expert on surgerymaxxing or something

 

[RealSurgerymax]

are u an expert on surgerymaxxing or something

Yes

 

[Marelago]

I don't think your protruding eyes are the issue, it's more that they are narrow set i.e. your IPD is the problem imo. The way to fix that via surgery is OBO which is something @RealSurgerymax has done

Happy for others to chip in here

Thanks. I will let measure my IPD by an optician. If it's less than the normal range what you say could definetely be true.

 

[Marelago]

Yes

Yes you are correct.

In this case we would move the orbits further apart and also advance them as a unit. Moving the periorbital rims forward in obo about 4mm would would have the exact same effects as orbital decompression except better for forward growth. We would do it at the same time as widening them.

This sounds very invasive. Interesting approach to moving forward the periorbital rims while moving apart the orbits.
How would OBO affect my midface cheeks, Nasion. Wouldn't these not be recessed even more when moving the Orbits forward?


Are you in touch with a cranio maxillo facial surgeon where has expertise in this area? When yes can I dicuss my case with him?

 

[Marelago]

My orbits didn't look narrow on the CT scan. I can show you scans as a child and my orbits looks wide apart. Almost every patient where OBD is recommended are already born with near set orbits. That's not the case for me.
It's more likely the position of the eyeballs in the globe that make this narrow impression. I would also like to mention that I have some sort of inward strabism (Esotropia), that was determined from experts.
But they don't whant do strabism surgery because I don't have double images and my vision is fine. But lately I've been getting smart, that strabism surgery in adults is usually succesful only for cosmetical purpose .I have the misfortune of living in a country where strabism surgery is not performed on people only for cosmetic issues because supposedly the risks (double vision, other complications) exceeds the success perfoming strabism surgery.
But this idea is outdated (because the brain can readjust). If anyone knows one (strabism surgeon) that is excellent I would go this route first. Because it's an extremely small intervention in comparison to OD or even OBD.

Yesterday i did some simulation in front of the mirror pressed the eyeballs a few mm wider away (simulation strabism surgery) and it did wonders. My eye looked straight and amazingly my protrudet eyeballs when lifting the head vanished.

 

[insecurehtn]

Hi
I'm a longtime sufferer abouth how my eyes looks. At this point I have to say, that I already had upper Ptosis surgery on both eyes and an endoscopic browlift to lift my eybrows. I whant more hooded eyes with less upper eyelid exposition and lower exposure sclera on the sides with lower eyelid surgery.
I think that the endoscopic browlift lifted my soft tissue to much so my upper eyelids are hollow and prominent.
I was by many oculoplastic surgeons, and also maxillo facial surgeons. A wide variety of opinions are available to solve the problem:

Orbital decompression: this idea came from an US surgeon Because He thinks that he can't archieve a natural result only with fixing upper eyelid overcorrection (from ptosis surgery), and lift the lower eyelids lateral with canthoplasty. So he would do OD and correction eyelids.
I'm hesitant abouth this surgery because it's relatively invasive and other oculoplasti surgeon said that I have eyeballs in normal range after he measured it. But the us surgeon is right that my cosmetic eye problem would be solved with OD and some work on the eyelid in the best manner. He said me also that I would look 30-40 percent better with OD and eyelid surgery. It would cost me around 24k usd with anasthesia and staying one night in hospital.
Other oculoplastics would only correct the left upper eyelid (overcorrection).
Some maxfacs said that the problem are the flat cheeks that would pretend that I have overexposed eyeballs. Some surgeon would do an augmentation with bone grafts foremost paranasal.

I'm torn between the proposed OD from US surgeon or do a more conservative approach like fixing only the eyelids (foremost the left eye), cheek augmentation.
A reverse browlift is also pretty invasive but I would take this surgery also in consideration.

What you think? Thanks

I'd say you need orbital decompression in one eye. Your 1 eye bulges significantly more than the other and it would help increase symmetry.

 

[Marelago]

I'd say you need orbital decompression in one eye. Your 1 eye bulges significantly more than the other and it would help increase symmetry.

Dude you're right. I never paid attention to it that maybe only one eye is much more protruding.
When I do OD you would do both eyes, but good to know that this is likely to generate the assymetrie in my face.

I suppose you figure it out based on the CT scan. I draw a horizontal blue line and it's clear one eye is off the rails.

Is the CT from above or below to determine which eye is affected?

left or right eye?

 

[Tenshi]

grandpa-cel

 

[RealSurgerymax]

This sounds very invasive. Interesting approach to moving forward the periorbital rims while moving apart the orbits.
How would OBO affect my midface cheeks, Nasion. Wouldn't these not be recessed even more when moving the Orbits forward?


Are you in touch with a cranio maxillo facial surgeon where has expertise in this area? When yes can I dicuss my case with him?

I have expertise in this area. I invented the method of this surgery and have a patent on the guides necessary to do it without using a craniotomy. Yes I work with a plastic and a maxillofacial surgeon.

 

[Marelago]

grandpa-cel

shut the fuck up

 

[Marelago]

I have expertise in this area. I invented the method of this surgery and have a patent on the guides necessary to do it without using a craniotomy. Yes I work with a plastic and a maxillofacial surgeon.

I don't need it. It's not the distance between the eye that's the problem it's the high set brows, the eyelid assymetry and proptosis (protruding eyeballs).
First thing would be fixing overcorrected eyelid left. lower brows with botox .
If the eye is still protruding (it's much more the left eye than the right). Than orbital decompression .

Good thing is I have positive canthal tilt (because I have high set cheeks) OBO would change this.

 

[Marelago]

High cheeks but very very flat. As already said my jaw and midface is recessed. And this should also be adressed.
I don't think that OD alone would do the job. it is an interaction of many things that I don't look grey chad lite (old grandpa in the house).
the face I admit it's a mess. Just already the crooked nose..... but eye distance it's not the problem here. I would do Lefort3 first than OBO (because this would solve my problems, protruding eyes. and my recessed midface), when surgical strategies don't convince me OD, reverse browlift, cheek augmentation.

 

[RealSurgerymax]

I don't need it. It's not the distance between the eye that's the problem it's the high set brows, the eyelid assymetry and proptosis (protruding eyeballs).
First thing would be fixing overcorrected eyelid left. lower brows with botox .
If the eye is still protruding (it's much more the left eye than the right). Than orbital decompression .

Ok

Good thing is I have positive canthal tilt (because I have high set cheeks) OBO would change this.

No it wouldn’t

 

[SubhumanityForce]

They do protrude, but it doesn’t seem bad enough to affect health, when traditional ODs are usually done. But I think it would result in a more natural look, especially if you get implants after. That’s the main thing.

No, they don't protrude at all. See his side view.

 

[SubhumanityForce]

Yes you are correct.

In this case we would move the orbits further apart and also advance them as a unit. Moving the periorbital rims forward in obo about 4mm would would have the exact same effects as orbital decompression except better for forward growth. We would do it at the same time as widening them.

What happens to the medial lateral canthi ligaments when you move the periorbitald forward? Do the also move forward as well? Meaning that the 2 anchors of your eyelids will go forward, covering more of your eyeball?